Last week, Texas hit the grim milestone of 10,000 COVID-19 deaths.
That is, it did when you went through local news stores and the Johns Hopkins Coronavirus Resource Center. The Texas Department of State Health Services reported a similar figure until Monday at 5 p.m.
That small, seemingly modest inconsistency could easily have been remedied – especially in the context of deviant COVID-19 stats across the country – if it were not for the fact that the state has passed weeks of despair, distrust in Texas resistance. State officials have blamed coding errors, system upgrades, backlogs, changes in methodology and closure of test centers for a recent rise of red flags in its coronavirus statistics.
Despite the cause, the flurry of questions about numbers ranging from infection rates to total deaths have made it difficult to clear up Image of what happens in the virus-destroyed state, public health experts told The Daily Beast. That would be in its own right, but it’s especially scary because the state uses that data to make decisions about school openings and other facilities as summer turns.
“There’s just a fog around Texas right now about what’s actually happening,” said David Rubin, director of PolicyLab at Children’s Hospital of Philadelphia, whose models of COVID-19 have played a role in White House policy-making. “Things are a bit messy.”
“It makes no sense,” Drs. David Lakey, vice chancellor of health affairs and chief medical officer at the University of Texas system and a member of the Texas Medical Association COVID-19 Task Force, told The Daily Beast of the state’s positivity figures last week .
Positivity figures reflect the proportion of tests that COVID-19 positively returned from the total number performed. It is an indicator, experts generally agree, whether enough tests are being carried out to paint a complete picture of the caseload of a region – as, more clearly, how widespread the infection is. As of Monday, Texas had 555,394 cumulative cases of the virus, according to data from Johns Hopkins, and a positivity rate in the past week of 12.95 percent.
But as Lakey explained it, things became strange about July 27, when the state changed its method of killing the dead, instead of infections. Sspecifically, that responsibility passed from someone who was placed on local health departments to a calculation based on death certificates. More than 400 previously unreported deaths were added to the total death toll in that single day.
“Suddenly it looked like dead sky-rocket,” Lakey told The Daily Beast.
Days later, according to the Texas Tribune, an “automation error” caused about 225 deaths to be incorrectly added to the total state control. They were later removed after a quality check on the information revealed that COVID-19 was not the direct cause of those deaths.
But as soon as those deviations were explained and began to seep out, after the shift in the reporting, another – equally disturbing – began to emerge.
An early August upgrade increased the capacity of the Texas Department of State Health Services from 48,000 to more than 100,000 electronically submitted test results per day, a spokeswoman told the Tribune.
Last week, the seven-day positivity rate suddenly went up dramatically, to about 25 percent on average in the week ending August 11th. For comparison, the positivity rates in New York State have fluctuated below 1 percent in recent days. Texas attorney Greg Abbott said in May that if the state’s positivity rate went above 10 percent, it would be considered a red flag.
That red flag has been present every day since the end of June. Even local and state experts on the ground told The Daily Beast last week that the actual information coming from hospitals around the state seems to clash with such enormous levels of positivity. Those findings were supported by national experts who said the rates were not in line with hospitalization numbers.
Meanwhile, the number of COVID-19 tests reported in Texas jumped to 124,693 in a single day on Thursday, August 13, after declining in previous days, according to the Texas Tribune. A Texas Department of State Health Services spokesman told the news website that the jump was “the result of coding errors and a system upgrade,” as well as backlogs in labs that could not be added until the bugs were corrected.
Before the pandemic, about 1,200 lab results a day were sent to the Department of State Health Services, but that has increased dramatically. Now the data comes in much larger quantities from labs across the state, which are sorted by their format – including faxes and electronic records – and then uploaded to the Center for Disease Control and Prevention’s National Electronic Disease Surveillance System.
On Sunday, experts told The Daily Beast that the positive test percentage of Texas looks more similar, as it dropped to 11.25 percent after a fourth straight day of decline, according to a Houston Chronicle analysis of state data.
When these problems arose, the data changed in one different (probably related) way: The number of reported tests dropped, which Abbott said he would investigate. The mayor has since noted that a possible explanation for the drip was the closure of temporary test sites, which were opened in July to help treat hot spots. Others have noted a drop in demand for diagnostic tests, a claim apparently supported by the claims of the state health department, to the Tribune, that community testing websites have “sufficient capacity” and few, if any, lines.
In another twist, a coding error by Walgreens Pharmacy led to an undercount of about 59,000 coronavirus test results in the state, KVUE-TV reported.
Diana Fite, president of the Texas Medical Association and an emergency physician based in Houston, explained that what holds a positivity score high is when “most people who do tests do so because they are sick.” A lower positivity rate will only be noticed once enough people have entered for tests that return more of their negative, but with current test capacity in the state, “you just can’t do that right away,” Fite said.
And although, she thinks, “that makes 11.25 percent more sense,” she can still “not really say how accurate it is.”
Those fluctuations, which Fite recognized were “Confusing,” even for professionals, have raised concerns about Texas’ ability to – however treat it – track the spread of the virus as schools make major decisions again this week in cities from Houston to San Antonio.
Great changes in the figures, said Fite, “make everyone trust nothing.”
Neither the Gov Abbott office nor the Texas Department of State Health Services responded to requests for comment from The Daily Beast. But the latter told CNBC last week that it “looked into the situation and reached out to clinical labs and statewide health care associations.”
“We are investigating why the number of lab tests reported to DSHS in recent days is trending,” Lyndsey Rosales, a spokeswoman, told the news website. “We analyze our data closely to detect anomalies.”
So what do experts say about school boards or counties like the average Texan trying to make decisions about the safety of their children?
“Without really good data, it will be difficult to navigate and know where we are in response,” Lakey said. “If you do not know that you can trust that positivity rate and the matter counts, then you fly blind.”
Still, according to Fite, the answer in the meantime is the same as it always has been: Pay attention to the broad trends instead of the specific numbers. Look at all the metrics together, instead of relying on one. And be careful.
Whatever the positivity figures, Fite said, “People at risk, who have chronic illnesses as parents, should remain quarantined.”
“Anyway, it’s still there,” she added.
.
